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Psychiatric Consultation in a Psychotropic Medication Oversight Program for Foster Children: The Illinois Model. Michael W. Naylor, M.D. University of Illinois at Chicago Director, Clinical Services in Psychopharmacology. Background. Historical context

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Psychiatric Consultation in a Psychotropic Medication Oversight Program for Foster Children: The Illinois Model

Michael W. Naylor, M.D.

University of Illinois at Chicago

Director, Clinical Services in Psychopharmacology


Background
Background Oversight Program for Foster Children: The Illinois Model

  • Historical context

    • DCFS challenged by federal courts, DOJ and ACLU

      • inadequate casework

      • chaotic and dangerous placements

      • substandard care

    • Illinois violating constitutional rights of children


Background1
Background Oversight Program for Foster Children: The Illinois Model

  • Historical context

    • ChicagoTribune 1995 editorial series:

      • DCFS called “the worst child welfare system in America…” and “a cruel, indifferent bureaucracy that harms kids.”

      • “system of shame”


Background2
Background Oversight Program for Foster Children: The Illinois Model

  • Historical context

    • Federal court-approved consent decree (B.H. v Suter, 1991)

      • DCFS and ACLU agree to collaborate on system reform plan


State context
State Context Oversight Program for Foster Children: The Illinois Model

  • Psychotropic medication consent

    • DCFS Rule 325

    • Clinicians wishing to start a foster child on a psychotropic medication must obtain consent from the DCFS Guardian


State context1
State Context Oversight Program for Foster Children: The Illinois Model

  • DCFS Psychotropic Medication Consent Program

    • Two components:

      • Centralized Psychotropic Medication Consent Line

        • Office of the DCFS Guardian

      • Clinical Services in Psychopharmacology

        • University of Illinois at Chicago


State context2
State Context Oversight Program for Foster Children: The Illinois Model

  • Centralized Psychotropic Medication Consent Line

    • Office of the DCFS Guardian

      • legal guardian for children committed to the Department

      • responsible for providing consent for medical, surgical, and psychiatric treatment


State context3
State Context Oversight Program for Foster Children: The Illinois Model

  • Clinical Services in Psychopharmacology

    • provide independent review for all psychotropic medication requests

    • monitor utilization of psychotropic medications

    • provide consultation on particularly complicated cases


State context4
State Context Oversight Program for Foster Children: The Illinois Model

  • Clinical Services in Psychopharmacology

    • notify the Guardian where provider patterns warrant review

    • conduct training for DCFS, foster parents and childcare providers on psychotropic medications

    • disseminate information regarding new pharmaceutical developments and alerts


Consent Process Oversight Program for Foster Children: The Illinois Model


Psychotropic medication request form
Psychotropic Medication Oversight Program for Foster Children: The Illinois ModelRequest Form

  • Demographic information

  • name

  • DCFS ID Number

  • date of birth

  • sex

  • race

  • weight and height

  • placement

  • physician’s name and specialty


Psychotropic medication request form1
Psychotropic Medication Oversight Program for Foster Children: The Illinois ModelRequest Form

  • Clinical information

    • diagnosis

    • current medications and dosage

    • symptoms/rationale

    • requested medication

      • dosage and frequency


Consultation
Consultation Oversight Program for Foster Children: The Illinois Model

  • Three main providers of consultation for clinicians treating foster children:

    • Clinical Services in Psychopharmacology

    • DocAssist

    • Consult for Kids


Clinical services in psychopharmacology
Clinical Services in Oversight Program for Foster Children: The Illinois ModelPsychopharmacology

  • Consultation

    • consent process

      • independent review of the appropriateness of the psychotropic medication consent request

      • recommend action to DCFS

        • approve

        • deny

        • modify


Clinical services in psychopharmacology1
Clinical Services in Psychopharmacology Oversight Program for Foster Children: The Illinois Model

  • Consultation

    • oversight

      • formal

        • high risk prescribers

        • emergency medication utilization

      • informal

        • feedback from Administrative Case Reviews

        • concerns expressed by caseworkers, regional nurses, guardian ad litem, Court Appointed Special Advocates, judges, Office of the DCFS Guardian


Clinical services in psychopharmacology2
Clinical Services in Psychopharmacology Oversight Program for Foster Children: The Illinois Model

  • Consultation

    • clinical

      • clinical concerns that arise in the course of the independent medication review

      • MD:MD

      • review of consent history

      • chart review

      • face-to-face


Clinical services in psychopharmacology3
Clinical Services in Psychopharmacology Oversight Program for Foster Children: The Illinois Model

  • Consultation

    • prior authorization

      • provided consultation to HFS vis-à-vis prior authorization for antipsychotic medications and stimulants for children

      • DCFS consent for a medication serves as prior authorization for foster children


Clinical services in psychopharmacology4
Clinical Services in Psychopharmacology Oversight Program for Foster Children: The Illinois Model

  • Consultation

    • systemic

      • consult on development of policies, best practice guidelines re: mental health care for foster children

      • co-write legislation


Clinical services in psychopharmacology5
Clinical Services in Psychopharmacology Oversight Program for Foster Children: The Illinois Model

  • Consultation

    • monitoring/QI

      • medication utilization patterns

        • rate of copharmacy with two or more antipsychotics

        • rate of polypharmacy by age group

      • timeliness of consent process

      • compliance with Rule 325


Impact of consultation
Impact of Consultation Oversight Program for Foster Children: The Illinois Model


Consultation1
Consultation Oversight Program for Foster Children: The Illinois Model

  • Illinois DocAssist

    • established through the joint efforts of the Department of Healthcare and Family Services, the Department of Human Services – Mental Health, and the University of Illinois at Chicago

    • funding support by the Illinois Children’s Mental Health Partnership


Consultation2
Consultation Oversight Program for Foster Children: The Illinois Model

  • Illinois DocAssist

    • clinical

      • quality of treatment for Medicaid funded children with mental illness in the primary care setting

    • client – Medicaid funded providers with a focus on primary care

    • purpose – improve the identification, diagnosis and treatment of children and youth with mental health issues through consultation, education and referral services


Consultation3
Consultation Oversight Program for Foster Children: The Illinois Model

  • Consult for Kids Program

    • established by DCFS to provide primary care clinicians participating in HealthWorks with resources to evaluate foster children in their care for mental health and behavioral concerns


Consultation4
Consultation Oversight Program for Foster Children: The Illinois Model

  • Consult for Kids Program

    • clinical

      • address questions and concerns about a foster child’s emotional, interpersonal, behavioral or cognitive problems

    • client – primary care providers

    • purpose – help primary care providers navigate a challenging child through the child welfare system


Consultation5
Consultation Oversight Program for Foster Children: The Illinois Model

  • Challenges to effective consultation

    • “silo-ization”

      • duplication of services

      • lack of coordination

    • informing stakeholders of the services

    • meeting demand for services


Consultation6
Consultation Oversight Program for Foster Children: The Illinois Model

“The Curse of Unwelcome Oversight

and Unrequested Consultation.”


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